Child refugees from CAR sit in the Chadian village of Sido. Many refugees, including children, have witnessed horrible events that will be difficult to process.

The refugees fleeing Central African Republic (CAR) have had to endure a torturous journey before finally reaching Sido, on the Chadian side of the border. After witnessing the massacre of their neighbors and relatives in CAR, they arrive exhausted both physically and mentally after traveling hundreds of miles packed in trucks or vehicles escorted from CAR’s capital, Bangui, by the Chadian army. Dr. Frédérique Drogoul, a psychiatrist with Doctors Without Borders/Médecins Sans Frontières (MSF), talks about the lives torn apart by violence and exile.

“Most of the refugees who told me their stories did so in a monotone, with solemn faces, without going into details about the bodies carved up in the massacres, keeping their distance from the expression of painful emotions," Drogoul said. "One man whose wife and children had been savagely killed told me, ‘you have to bottle things up, otherwise you go mad.’”

Drogoul is returning from Sido, where MSF opened a health center and a hospital unit in early February to meet the urgent medical needs of some 13,000 refugees.

“Despite the terrible stories I heard throughout my visit, I often had the feeling that the painful memories were being held in check by a staggering effort,” Drogoul said. That was the case with the grandmother of Abdel and Zacharia, two brothers about 20 years old. “She seemed very detached,” he said. Residents of the Kilo 5 neighborhood in Bangui, the three arrived in Sido in one of the convoys organized by the Chadian army. Twenty-eight members of their family had been massacred.

“When I met him, Abdel was really not there,” said Drogoul. “He was sitting down and mumbling from time to time. His grandmother told me that when his older brother was decapitated before his eyes, Abdel ran out screaming. He has not recovered since.” Zacharia, Abdel’s younger brother, was not with them at the time. He was working in his shop, which was also attacked. He said that the anti-balakas tied up his arms before throwing a grenade into the shop. Part of his right hand was torn off and he was hit in the right eye.

“Zacharia was reunited by chance with his grandmother and Abdel in Sido. Now he is anxious, exhausted, worried about his grandmother, who is not able to do very much, and a brother who is psychotic and no longer self-sufficient. It’s a very heavy burden for him,” said Drogoul. The family is being supported and receiving medical help from the MSF team in Sido.

In addition to the violent incidents experienced at home, there are those that sometimes occur on the long journey to Chad. Mariama is a ten-year-old Peulh girl. When Drogoul met her for the first time, she was accompanied by one of her older sisters. “She looked afraid. Her face was sad and closed. She did not speak on her own. It was her sister who told me their story,” Drogoul recalled.

Mariama’s parents were killed during the attack on Bossembélé and she fled into the bush with some neighbors. The husband of one of her older sisters managed to find her and brought her to their place in Bonali before they all fled to Bangui in one of the convoys escorted by the Chadian army. Their truck broke down on the road. “The escorted convoy did not stop and, according to Mariama’s sister, the anti-balakas immediately attacked. All the men—including the brother-in-law who had saved Mariama—were killed with machetes in front of the women and children.”

Some of the survivors were raped. Mariama was trampled. She complains of generalized pain. “On our third meeting she told me that, before abandoning them there in the middle of the night, the anti-balakas set fire to all their belongings, leading them to believe they would also be cooked in the fire and eaten,” Drogoul said. “While her sister was telling me all this, Mariama was listening and nodding her head to what her sister said. I was really touched when they spoke about tears. Her older sister said to me, ‘if she cries, I also start to cry. It’s too hard.' I had the impression that speaking about it helped to ease the terror, and at our last meeting her sister told me that Mariama was no longer crying, that she had begun to participate in activities appropriate to her age.”

Around 60 miles from Sido in Doyaba, a special reception site has been set up for unaccompanied minors, all the children who arrive alone, separated from their families. There are about 400 children there, but there are more than 1,000 throughout southern Chad, according to the United Nations Children’s Fund (UNICEF). Four young brothers had arrived several weeks ago in Doyaba with wounds from machete blows on the skull. Two of the boys’ fingers were deliberately mutilated.

“The two older ones, seven or eight years old, seem to be getting better,” Drogoul said. “The wounds have healed and they play quietly with the other children. However, the two younger ones are isolated, withdrawn, and still stare blankly.”

In addition to the trauma of the violence suffered in CAR, there is also the pain of family separation. For Drogoul, “it is essential to work for the reunification of families, for example, by examining the lists drawn up by UN agencies in Chad and in CAR or by setting up telephone booths, as the ICRC has already done in Goré and Doyaba—to enable the refugees to call their relatives or neighbors and to re-establish contact with those they have lost.”

“It’s survival from day to day. Mental life seems suspended,” he said. “There is little room for memories of terror, no space to imagine a future for oneself. To have survived and managed to protect one’s children is what counts above all now,” said Drogoul. “But when the minimum conditions for survival are finally provided to the refugees, it is likely that situations of great distress, even of psychic collapse, will become more frequent.”

MSF has been operating in Chad for over 30 years. In addition to emergency programs established in February in N’Djamena, Bitoye, Goré, and Sido to meet the medical and humanitarian needs of the refugees from the Central African Republic, MSF teams operate regular programs in Abéché, Am Timan, Massakory, Moissala and Tissi.